Failure to Offer Non-Pharmacological Pain Interventions Prior to PRN Narcotic Administration
Penalty
Summary
The facility failed to ensure that physician-ordered non-pharmacological interventions were offered to residents prior to the administration of as-needed (PRN) narcotic pain medications. This deficiency was identified through record review, policy review, and staff interviews, and was found to affect three residents with significant medical histories, including low back pain, dementia, vertebral fractures, arthritis, and a history of substance use disorder. For each resident, physician orders specifically directed staff to offer interventions such as rest, positioning, distractions, and application of cold or heat packs before administering PRN narcotic pain medications. Despite these orders, medication administration records for all three residents showed repeated administration of narcotic pain medications without any documentation that non-pharmacological interventions were offered beforehand. In one case, a resident received a narcotic pain medication 69 times in a single month with no record of non-pharmacological interventions being attempted. The Director of Nursing confirmed the absence of such documentation for all three residents, acknowledging that the interventions should have been offered prior to medication administration.